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By Connor Radnovich
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The contract, Diamond says, is between the hospital and the insurance company. Any discounts are determined by the insurance company based on its contract with the hospital.
"They calculate it at their end, and we book it at the discounted rate on our books," Diamond says.
But at least one state insurance plan considers any policy under which insurance companies fail to share the benefits of hospital discounts with customers to be unethical. Blue Cross/Blue Shield spokesman Dave McIntyre condemns the practice.
"Quite frankly, we find it deplorable that some have seen fit to do one thing with a customer, and cut a deal on the side to enrich their pockets," he says. "It's just plain wrong in our view."
McIntyre says Blue Cross/Blue Shield uses the same charge as its customers when it calculates payments to health-care providers.
"To do anything different is a total financial sleight of hand, and it is wrong," he says.
While battling with CIGNA in the courts, La Donna Sell faces another challenge, one that requires her to deal on an almost daily basis with the insurance company and its physicians.
For the last five months, La Donna has undergone extensive chemical and radiation therapy to battle cancer. She also had surgery that resulted in numerous complications. She has been left weak, thin, frail.
"It's been a rough summer," she says in a soft, barely audible voice.
Is CIGNA any better now than it was four years ago when a prescription mistake nearly ended her life?
"I can't say that," she says. "I haven't been happy with them for a long time."
La Donna says the company still maintains the attitude it had in 1990, when it refused to pay her ambulance bill because she didn't seek permission to call for emergency help while lying unconscious on the floor of her house.
"They do what they have to do," she says. "And no more.